Analysis Of Caregiving Burnout Status Of Primary Caregivers Of Patients With Severe Mental Illness And Its Influencing Factors

Objective: To test the applicability of Maslach Burnout Inventory-General Survey(MBI-GS)in measuring caregiving burnout of primary caregivers of patients with severe mental illness.To investigate the status and influencing factors of caregiving burnout in this population.The above aims are expected to provide an evidence-based basis for the development of a caregiving burnout scale for the primary caregivers of patients with severe mental illness and the development of targeted interventions in the future.Methods: The explanatory design method of mixed method design was adopted in this study.Quantitative data were collected and analyzed first.Then,the characteristics of subjects in the quantitative study(the degree of caregiving burnout)guided the sampling of subjects in the qualitative study stage.(1)Quantitative study: From July 2021 to January 2022,277 primary caregivers of inpatients with severe mental illness were selected from the psychological ward of two tertiary hospitals in Hunan province.The survey tools included a general information questionnaire,MBI-GS,Zarit Caregiver Burden Interview(ZBI),Positive Aspects of Caregiver(PAC),Social Support Rating Scale(SSRS),General Self-Efficacy Scale(GSES),Perceived Devaluation-Discrimination(PDD)and Simplified coping style questionnaire(SCSQ).The obtained data was input into SPSS 26.0 and Amos26.0.The reliability of the scale was tested by calculating Cronbach’s α coefficient,and its structural validity was tested by exploratory factor analysis and confirmatory factor analysis.Descriptive statistical analysis was conducted on the data by frequency,constituent ratio,mean and standard deviation.Mann-whitney U test,Kruskal-Wallis H rank-sum test,correlation analysis and multiple ordered logistic regression were used to explore the influencing factors of caregiving burnout.(2)Qualitative research: This part used a phenomenological research method.Based on the inclusion and exclusion criteria in the quantitative study,the primary caregivers with mild,moderate,and severe burnout were selected as research objects by purposeful sampling method,and the significant general data variables of single factor analysis in quantitative studies were taken into account.The qualitative part adopted Semi-structured interviews,and the interview data was analyzed by Colaizzi phenomenological seven-step analysis method.Results:(1)Applicability of the scale: 1)Reliability and validity: the Cronbach’s α coefficient of MBI-GS was 0.737,and the consistency coefficients of each dimension of MBI-GS were 0.937,0.786 and 0.854,respectively.Exploratory factor analysis results showed that three factors were extracted,corresponding to three dimensions of MBI-GS,and the cumulative variance explanation rate was 66.960%.Confirmatory factor analysis results showed that the initial model had a general fit,while the revised model had a good fit.2)The feelings of caregiving burnout and the expansion of its dimensions: through the analysis of semi-structured interview data,five topics are extracted: the feelings of caregiving burnout,physiological performance,psychological performance,behavior and attitude performance,and time characteristics.(2)The score of the emotional exhaustion dimension of MBI-GS scale was 11.23±8.85,the depersonalization dimension was 2.88±3.89,and the personal accomplishment dimension was 17.55±9.27.Among the277 caregivers,32.5% felt mild burnout,19.9% felt moderate burnout,and 7.2% felt severe burnout.(3)The results of single factor analysis showed that MBI-GS scores of primary caregivers of patients with severe mental illness were significantly different for caregivers with different health status and family monthly income per capita(P<0.05).MBI-GS was positively correlated with PAC,SSRS,GSES,and positive coping dimension of SCSQ(P<0.05),and negatively correlated with ZBI and PDD(P<0.05).The results of ordered logistic regression analysis showed that two factors(caring burden and social support)entered the regression equation.The risk of burnout of caregivers with heavy care burden was higher than that of caregivers with light care burden(OR=1.041,95%CI=1.026-1.057).Caregivers with high social support had a lower risk of burnout than those with low social support(OR=0.958,95%CI=0.926-0.991).Conclusions:(1)The reliabilities and validity of the MBI-GS was acceptable,indicating that the MBI-GS scale can be used to measure the caregiving burnout of the primary caregivers of patients with severe mental illness.However,according to the results of qualitative data,MBI-GS scale can be considered to add an evaluation index of overall caregiving burnout level.The dimensions of MBI-GS scale should be expanded on the basis of the original scale.For example,physical,psychology and behavioral attitude performance can be more targeted,and time characteristics should also be considered,those indicated the need to develop a targeted care-giving burnout scale.physiological performance,psychological performance,behavior and attitude performance,and time characteristics.It is necessary to develop a nursing burnout scale.(2)In the quantitative part of this study,most(59.6%)of the primary caregivers of patients with severe mental illness felt caregiving burnout,more than a quarter of the caregivers felt moderate burnout,and more than 7% of the caregivers felt severe burnout.The influencing factors of caregiving burnout among primary caregivers of patients with severe mental illness were caregiver burden and social support.Intervention measures should be taken in the future to further reduce the burnout of the caregivers.